Provider Demographics
NPI:1568624732
Name:JANICE GRIFFIN PHD LLC
Entity Type:Organization
Organization Name:JANICE GRIFFIN PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-385-0340
Mailing Address - Street 1:4004 CARLISLE BLVD NE STE R
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4544
Mailing Address - Country:US
Mailing Address - Phone:505-385-0340
Mailing Address - Fax:505-880-1213
Practice Address - Street 1:4004 CARLISLE BLVD NE STE R
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4544
Practice Address - Country:US
Practice Address - Phone:505-385-0340
Practice Address - Fax:505-880-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty